Healthcare Provider Details

I. General information

NPI: 1578800157
Provider Name (Legal Business Name): DURAMED, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2013
Last Update Date: 01/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11135 INDUSTRIPLEX BLVD SUITE 800
BATON ROUGE LA
70809-4114
US

IV. Provider business mailing address

1015 24TH ST
KENNER LA
70062-5268
US

V. Phone/Fax

Practice location:
  • Phone: 225-751-1224
  • Fax: 225-751-1224
Mailing address:
  • Phone: 504-467-4057
  • Fax: 504-467-4053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. RICKY WALTER DECASTRO SR.
Title or Position: PRESIDENT
Credential:
Phone: 504-467-4057